Abstract
Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.
Highlights
At least 25% of chronic kidney disease (CKD) patients have limited health literacy (LHL) [1], which is associated with faster kidney function decline and higher mortality [2,3,4].Health literacy (HL) is ‘the degree to which people are able to access, understand, appraise and communicate information to engage with the demands of different health contexts to promote and maintain good health across the life course’ [5]
Within the objectives aiming to improve the knowledge and competences of patients, we thought there was an important role for healthcare professionals (HCPs), and added multiple determinants to improve the competence of HCPs in supporting patients with LHL
This is important as, according to the experiences of patients, effective communication is the key to improved self-management
Summary
At least 25% of chronic kidney disease (CKD) patients have limited health literacy (LHL) [1], which is associated with faster kidney function decline and higher mortality [2,3,4].Health literacy (HL) is ‘the degree to which people are able to access, understand, appraise and communicate information to engage with the demands of different health contexts to promote and maintain good health across the life course’ [5]. At least 25% of chronic kidney disease (CKD) patients have limited health literacy (LHL) [1], which is associated with faster kidney function decline and higher mortality [2,3,4]. To improve the health outcomes of CKD patients with LHL, it is necessary to tailor healthcare to their needs [6]. Patients with LHL often have insufficient self-management capacities [7,8,9]. Selfmanagement is defined as the ability to manage the symptoms, treatment, physical and psychosocial consequences, and lifestyle changes inherent in living with a chronic condition. Efficacious self-management encompasses the ability to monitor one’s condition and to affect the cognitive, behavioral and emotional responses necessary to maintain a satisfactory quality of life [10]. Interventions directed at patients have been proven effective at optimizing self-management [10]
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